UTI

Question 1

Lower UTI symptoms

Answer 1

Dysuria
Urgency
Frequency
Suprapubic aching
Haematuria
Strangury

Question 2

Pylonephritis symptoms

Answer 2

HIgh fever
Rigor
Vomiting
Loin pain/tenderness

Question 3

Pathogens

Answer 3

Gram negative rods from patient’s own perineal flora
Common: E coli, Staphylococcus, Saprophyticus
Less common: Proteus spp, Enterobacter spp, Morganella spp, Klebsiella spp, GpB Strep, Enterococci sp
Fungi: Candida albicans
Mycobacteria: TB
Viruses: Adenovirus

Question 4

Investigation

Answer 4

Turbidity
Dipstick
MSU - WCC, cells/organisms, culture
Terminal urine - concentrates ova (eg schistomiasis)
Early morning urine - renal TB
Imaging - US for abscess, abnormalities; Intravenous urogram (IVU) for structural deficits

Question 5

Causes of sterile pyuria

Answer 5

Urinary stones
Urinary tract tumours
Drug reactions
Chlamydia
Brucellosis
TB
True UTI partially suppressed by antibiotics

Question 6

Empirical treatment

Answer 6

Women: oral trimethoprim, nitrofurantoin or coamoxiclav for 3 days
Men: oral trimethoprim, nitrofurantoin or coamoxiclav for 7 days
Pregnant women: coamoxiclav, cephalexin or nitrofurantoin 3-7 days
Men, suspicion of prostatitis: coamoxiclav or ciprofloxacin for 14 days
Pylonephritis: Tazocin IV or cefuroxime IV then oral abx 10 days minimum
Abscess: surgical drainage

Question 7

Asymptomatic bacteruria

Answer 7

Pregnant women should receive treatment due to ↑ risk of upper UTI, preterm labour or low birth weight babies
Everyone else - don’t treat

Question 8

Symptomatic bacteruria in catheterised patients

Answer 8

Change catheter ASAP and treat

Question 9

Recurrent UTI

Answer 9

Prophylactic trimethoprim, nitrofurantoin, cefelexin
Cranberry products
Investigate for underlying cause